Placenta praevia is a known obstetric condition that causes complications to mother and fetus. This study was done to evaluate the knowledge of placenta praevia amongst the obstetric patients. A cross sectional study was carried out in Hospital Ipoh, Perak among 323 antenatal and postnatal patients. Socio-demographic parameters (ie age, race, parity, occupation, educational level) and history of placenta praevia were studied in relation to level of knowledge and attitude towards placenta praevia. Twenty (6.2%) from 323 women had current or past history of placenta praevia. Three had history of placenta praevia while 17 had current placenta praevia with prevalence of 5.3%. The mean score of knowledge achieved by patients was 11.8of education and history of placenta praevia were found to have a relationship with level of knowledge regarding placenta praevia in all obstetric patients. There was a significant relationship between attitude of patients with current and history of placenta praevia to level of knowledge regarding placenta praevia. (p=0.037, <0.05). In conclusion, the knowledge and attitude towards placenta praevia among obstetric patients in Hospital Ipoh was better in those who had higher education status, white-collar occupation and currently pregnant with placenta praevia. which indicated overall poor knowledge. Occupation, level

Background: The incidence of diabetes mellitus is ever increasing. Individuals with diabetes mellitus may have concurrent mental health disorders and are shown to have poorer disease outcomes. The objectives of this study were to determine the prevalence of depression, anxiety and stress (DAS) in diabetes patients aged 20 years or more in the primary care setting. Methods: This was a cross-sectional study involving the use of self-administered questionnaire conducted in eight primary care private and government clinics in Pulau Pinang and Melaka, Malaysia. The validated DASS-21 questionnaire was used as a screening tool for the symptoms of DAS. Prior permission was obtained from the patients and, clearance from ethical committee was obtained before the start of the study. Data analysis was done using SPSS statistical software. Results: A total of 320 patients with diabetes from eight centres were enrolled via convenience sampling. Sample size was calculated using the Kish’s formula. The prevalence of DAS among patients with diabetes from our study was 26.6%, 40% and 19.4%, respectively. Depression was found to be significantly associated with marital status and family history of DAS; anxiety was significantly associated with monthly household income, presence of co-morbidities and family history of DAS; and stress was significantly associated with occupation and family history of DAS. Conclusions: The prevalence of DAS was higher in patients with diabetes compared with the general community. We recommend to routinely screen all patients with diabetes using the DASS-21 questionnaire because it is easy to perform and inexpensive.

Methicillin-resistant Staphylococcus aureus (MRSA) infection is important among vas-cular surgical patients. Its effect can be devastating resulting in limb amputation and mortality. We performed a retrospective patients record analysis to determine the pat-tern of MRSA infection among vascular surgical patients in Hospital Kuala Lumpur from January 2005 to December 2007. We also attempted to identify the factors asso-ciated with poor clinical outcome after such infection. There were 999 patients who underwent vascular surgeries in HKL within the analysis period. Of these 24 patients (2.4%) were detected to have MRSA surgical site infection. The infection was commoner among cigarette smokers, patients with diabetes melitus and those who had previous vascular surgery. Most infections occurred in the emergency surgery category and manifested as wound breakdown. Fifty-four percent of the infected pa-tients ended with graft removal, amputations or death. MRSA infection complicating vascular surgery resulted in poor clinical outcome. This serious threat requires intensified preventive measures.

This study assessed the effectiveness of education reforms on student-reported learning outcomes at the end of the 5-year medical school (M5) and 1-year internship (HO) in 2006, 2007 and 2008. A self-administered anonymous survey with 17 learning outcomes assessed, derived from Harden's Three-Circle Outcomes Model for outcomes-based education, was administered to 683 students at the end of medical school (M5) and internship (HO) from 2006, 2007 and 2008. We identified learning outcomes which changed significantly for internship (Cohorts A, B and C) and medical school (Cohorts B, C and D) between cohorts from 2006 to 2008, and compared learning outcomes between medical school and internship within cohorts (i.e. Cohort B which was M5 in 2006 and HO in 2007; Cohort C which was M5 in 2007 and HO in 2008). The proportion of students who agreed that medical school helped them achieve learning outcomes increased significantly from 2006 to 2008 for 15 out of 17 learning outcomes assessed. The proportion of students who agreed that internship helped them achieve learning outcomes increased significantly from 2006 to 2008 for 6 learning outcomes assessed. For Cohorts B and C, internship was more effective than medical school in achieving 8 learning outcomes. Cohort C reported that internship was more effective than medical school in 3 additional learning outcomes than Cohort B: patient management, humility and dedication. We conclude that a successful journey of education reform is an ongoing process that needs to comprehensively address multifaceted components such as faculty, administration and curriculum.
Clinical Competence ; Curriculum ; Education, Medical, Graduate ; Education, Medical, Undergraduate ; Humans ; Internship and Residency ; Schools, Medical ; Singapore ; Surveys and Questionnaires

Objective: To study the application of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in hepatocellular carcinoma with mild-to-moderate liver cirrhosis. Methods: There are 14 patients with hepatocellular carcinoma underwent ALPPS at the Department of Hepatobiliary and Pancreatic Surgery, Hong Kong University-Shenzhen Hospital from April 2014 to December 2017. The clinical data was retrospectively studied. The studying objects consisted of 9 males and 5 females, aged from 26 to 71 years old with the average age of 51, all cases were of Child-Pugh grade A. The degree of liver cirrhosis, operation and postoperative complications were analyzed. Results: All 14 patients completed the ALPPS, 1 patient died post stage 2 operation with liver failure. Comparing the groups with no liver cirrhosis (n=4) with the groups of mild liver cirrhosis (n=5) and moderate liver cirrhosis (n=5), the future liver remnant liver volume growth rates were 58%, 46% and 45.6%, respectively. The average operation intervals were 9.0, 11.2 and 12.8 days, respectively. Postoperative complications occurred in 4 patients: 2 patients with liver failure, 1 patient with intestinal obstruction, and 1 patient with hepatic ascites. Conclusion ALPPS for Child-Pugh grade A, hepatocellular carcinoma with mild-to-moderate liver cirrhosis treatment is safe and feasible.